tbuckley/cabot-search huggingface dataset:
Abstract 13542: Associations of Pulmonary Artery Stiffness With Mortality in Pulmonary Arterial Hypertension
Authors: Kyle Nelson, Lindsay Elbaum, Carlos A Gonzalez Lengua, Ana Garcia-Alvarez, Javier Sanz
Journal: Circulation (2022)

Introduction: Pulsatility, the relative area change of the pulmonary artery (PA) during the cardiac cycle has been associated with impaired prognosis in pulmonary arterial hypertension (PAH), but other measurements of stiffness are not well explored. Hypothesis: Multiple indices of PA stiffness derived from cardiac magnetic resonance (CMR) and right heart catheterization (RHC) predict outcome in PAH Methods: Retrospective chart review on 108 patients with PAH who had a clinically indicated CMR and RHC within 90 days, and for the primary endpoint of all-cause mortality. From CMR and RHC data, PA areas and indexes of stiffness (pulsatility, compliance, capacitance, distensibility, elastic modulus, and the pressure-independent stiffness index beta) were measured. Data was analyzed using Cox-proportional hazards models. Results: We included 108 patients with average age of 51 (+/- 13) years, 79% female with a mean PA pressure of 46 +/-12 mmHg, and a mean right ventricular ejection fraction (RVEF) of 38 +/-14%. After a median follow-up of 6 years, 58 (54%) patients had died. Most indices of increased stiffness were associated with higher mortality after adjusting for age, sex, diuretic use, mean PA pressure and RVEF ( Table ). Conclusions: Among patients with PAH, most measurements of PA stiffness strongly correlated with mortality.
Abstract 13303: Influence of ARNI on Cardiac Autonomic Nervous System
Authors: Andreas A Boehmer, Tim Schubert, Lukas von Stuelpnagel, Axel Bauer, Bianca Dobre, Bernhard M Kaess, Joachim R Ehrlich
Journal: Circulation (2022)

Background Mortality in heart failure with reduced ejection fraction (HFrEF) is associated with imbalance of cardiac autonomic nervous system (CANS). Sacubitril/ Valsartan (ARNI) reduces risk of death and HFrEF hospitalization. Whether ARNI exerts effects on CANS has not been studied. Accordingly, we prospectively compared heart rate variability (HRV) as a noninvasive measure of CANS before and after initiation of ARNI therapy. Methods: The study was as a single-arm prospective interventional study. Patients with HFrEF underwent echocardiography and standardized 30-minute 12-lead Holter ECG recording before and 3 months after initiation of ARNI therapy. Study endpoints were changes in HRV parameters (standard deviation of normal-to-normal intervals (SDNN), mean square of differences between consecutive R-R intervals (RMSSD), periodic repolarization dynamics (PRD) and deceleration capacity (DC) as well as left ventricular ejection fraction (LVEF) and heart rate (HR). Results: Between June 2021 and March 2022 we recruited 63 consecutive patients. At follow-up 48 (76.2%) patients were still on ARNI and therefore analyzed. Mean age was 65±13 years, 88% were male. All patients received identical beta-blockers dosage at baseline and follow-up. Heart rate was reduced by ~12% (P=0.005). SDNN increased by ~42% (P&lt;0.001), RMSSD by ~55% (P&lt;0.001) and ~DC by 370% (P&lt;0.001). No change in PRD was observed (P=0.13). These results were accompanied by increased LVEF (28±6% vs. 38±10%, P&lt;0.001) and reduced plasma nt-proBNP levels (5083±790 pg/ml vs. 1838±621 pg/ml, P=0.002). NYHA class improved from III to II. Conclusion Significant increase of parasympathetic CANS tone was observed after initiation of ARNI therapy as evidenced by decreased HR, increased DC, SDNN and RMSSD. Part of the beneficial effects of ARNI might be related to the accentuation of parasympathetic CANS modulating mortality risk and risk for HFrEF hospitalizations.
Abstract 14404: Variation and Predictors of Referral for Cardiac Rehabilitation Among Patients With Heart Failure Before and After Expansion of Coverage and Association With 1-year Clinical Outcomes
Authors: Neil Keshvani, Vinayak Subramanian, Chris Wrobel, Nicole Solomon, Brooke Alhanti, Emily Guhl, Stephen J Greene, Larry A Allen, Clyde W Yancy, Adam D Devore, Gregg C Fonarow, Ambarish Pandey
Journal: Circulation (2022)

Introduction: The Centers for Medicare and Medicaid Services(CMS) expanded coverage for cardiac rehabilitation(CR) in 2014 for patients with clinically stable heart failure(HF) with reduced ejection fraction. Contemporary CR referral and participation rates among eligible patients with HFrEF are not known. Methods: Patients hospitalized for HF with ejection fraction ≤35% in the American Heart Association Get With The Guidelines®-HF(GWTG-HF) registry from 2010-2020 were included. Trends in rate of referrals and predictors of referral were determined. Among subset of participants with available Medicare-linked data, rate of CR participation was assessed, and 1-year outcomes were compared among patients referred vs. not referred to CR. Results: Of 69,441 HF patients eligible for CR, 17,076(24.6%) were referred to CR. There was substantial variability in referral across GWTG-HF participating centers (range 0-100%, IQR 4%-50%). Of patients with fee-for-service Medicare referred to CR, only 4.2% participated in CR in the year following HF hospitalization (median sessions: 3, range 1-76). Referral rate increased from 2010-2020, with significant increase since 2014 CMS coverage expansion (p trend &lt;0.001). Patients not referred were more likely to be older, of minority race, and with greater burden of comorbidities. Patients admitted to rural hospitals and those in the Northeast were less likely to be referred to CR. Among patients free of HF events within 30 days post-discharge, CR referral was independently associated with lower risk of 1-year all-cause mortality vs. those not referred (HR 0.84, 95% CI (0.73 - 0.98, p = 0.0267), without significant difference in 1-year HF-related or all-cause readmission. Conclusions: Although CR referrals have increased among eligible HF patients since CMS expanded coverage in 2014, absolute referral and participation rates remain low. Age, race, and burden of comorbidities were independently associated with CR referral.
Abstract 13365: Real World Clinical Outcomes Associated With Controlled versus Uncontrolled Blood Pressure in Patients With Apparent Treatment Resistant Hypertension
Authors: George Bakris, Mukul Singhal, Cindy Chen, Alicia Campbell, Lloyd Haskell, Veronica Ashton
Journal: Circulation (2022)

AHA estimated 10.3 million US adults with apparent treatment resistant hypertension (aTRH) in 2018; limited data exist regarding clinical outcomes for these patients. This retrospective cohort study assessed risk of major adverse cardiac events (MACE: stroke, myocardial infarction, heart failure hospitalization) and end stage renal disease (ESRD) among aTRH patients, comparing those with controlled blood pressure (CBP; SBP/DBP &lt;130/80 mm Hg) vs uncontrolled blood pressure (UBP; ≥130/80 mm Hg), using linked IQVIA Ambulatory EMR- US and IQVIA PharMetrics® Plus claims data. Patients taking ≥3 antihypertensive (anti-HTN) classes within 30 days (index regimen) between 1/1/2015 and 6/30/2021, having ≥2 BP values post-index regimen (2 nd BP date = index date) with ≥12 months pre-index enrollment (baseline) were included. Unbalanced covariates were adjusted in the multivariable model. Cohorts consisted of 11,427 CBP and 22,333 UBP patients: mean (SD) age 62 (13) vs 60 (12) years, female (48% vs 46%), African-American (8% vs 12%), mean (SD) baseline SBP/DBP 118 (8)/70 (6) vs 141 (14)/82 (9) mm Hg, mean (SD) BMI 32 (8) vs 34 (10) kg/m 2 , respectively. The index regimen consisted of 3, 4, or ≥5 anti-HTN classes in 82% vs 79%, 15% vs 18%, and 2% vs 3% of CBP vs UBP patients, respectively (all p&lt;0.001). Frequently observed baseline comorbidities in CBP vs UBP patients included hyperlipidemia (79% vs 76%), mild to moderate diabetes (43% vs 42%), chronic pulmonary disease (31% vs 25%), and congestive heart failure (27% vs 16%). Mean (SD) follow-up time was 2.7 (2.1) years for both cohorts. Patients with UBP were at 8% and 53% increased risk of developing MACE and ESRD, respectively, MACE risk was mainly driven by a 31% increased risk of stroke (figure). Despite being treated with 3+ anti-HTN classes, 66% of aTRH patients had UBP and demonstrated increased risk of MACE and ESRD compared to CBP patients. Development of future innovative treatment approaches can add value in the management of aTRH.
Abstract 12833: Evaluating Preferences for Data Access and Sharing Among Older Adults With Heart Failure and the Ethical Implications for Research
Authors: Stephanie Nino de Rivera, Sabrina Mangal, Meghan Reading Turchioe, Ruth M Masterson Creber
Journal: Circulation (2022)

Introduction: Health information collected during research studies is rarely returned to patients although it can provide benefits for ongoing clinical management. Little is known about preferences for data access and sharing from older adults with heart failure. Methods: The research team developed an interview guide based on participants’ perspectives on the ethical implications of data sharing and access in research studies. Interview length ranged from 20-40 minutes each. Qualitative data were analyzed using a directed content analysis approach. Two authors double-coded the first 10% of transcripts and discussed discrepancies to consensus, consulting additional reviewers at weekly meetings when needed. Results: Overall, 22 participants were recruited and the mean age was 72 (56-75) years, 27% were female, 14% were Hispanic/Latino, the majority were highly educated (95% completed college or above), and also reported a disability (54%). The three primary themes on the facilitators to data access and sharing were: support for self-management, enhancing clinician communication and motivation to help others (Table). The three primary themes on barriers to data access and sharing were: fear of loss of health insurance benefits, privacy concerns, and a lack of confidence interpreting complex health information. Conclusions: Older adults with heart failure strongly endorsed a preference for having access to health research information and being able to share that information with healthcare professionals to optimize management of their care. Psychological barriers to meaningful use of health information can be addressed through transparency with data use and access.
Abstract 13742: Left Atrial Appendage Closure versus Direct Oral Anticoagulant Outcomes Among High Risk Atrial Fibrillation: A Meta-Analysis
Authors: Vikash Jaiswal, Abdelrahman Attia, abhigan babu Shrestha, Amey Joshi, Akash Jaiswal, Kriti Kalra, Chetana Pasam, Monodeep Biswas
Journal: Circulation (2022)

Introduction: Relevant data comparing the beneficial approach towards atrial fibrillation (AF) patients with left atrial appendage closure (LAAC) and direct oral anticoagulation therapy (DOAC) is limited and not well known. Hypothesis: We aim to evaluate the clinical outcomes among AF patients who received LAAC and DOAC therapy. Methods: We systematically searched all electronic databases from inception until May 30th 2022 comparing cardiovascular outcomes among LAAC versus DOAC. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of &lt;0.05 was considered statistically significant. Results: A total of 6315 patients (LACC: 2703, DOACs: 3612) from six studies consisting of one RCT and five propensity-score-matched studies were included in our analysis. Compared with DOAC, LAAC cohort was associated with a significant reduction in primary composite outcome of ischemic stroke, major bleeding and all-cause mortality [OR 0.62, (95% CI 0.45 to 0.84), p=0.002]. Similarly, LAAC cohort showed a significantly reduced all-cause mortality [OR 0.61, (95% CI 0.43 to 0.87), p=0.006], CV mortality [OR 0.56, (95% CI 0.44 to 0.71), p&lt;0.001] and post-procedural bleeding [OR 0.57, (95% CI 0.40 to 0.83), p=0.003]. There were no significant differences in terms of ischemic stroke/TIA [OR 1.15, (95% CI 0.88 to 1.52), p=0.31] and systemic embolism [OR 1.01, (95% CI 0.49 to 2.07), p=0.97] between patients receiving LAAC or DOAC. Conclusions: LAAC shows superiority over DOAC in terms of reducing the all-cause mortality, cardiovascular mortality and major bleeding events among patients with high risk atrial fibrillation, however large multicenter randomised trials are warranted to further justify these findings among large sample size.
Abstract 13939: Catecholamine-Induced Cardiomyopathy and Limb Ischemia in Pheochromocytoma
Authors: Jayoung Lim, Hyoung-won Cho, Si-hyuck Kang
Journal: Circulation (2022)

Case Presentation: A 40-year-old woman who was 4 weeks pregnant presented with nausea and vomiting. Blood pressure (BP), heart rate, and temperature were 180/104 mmHg, 85 beats/min, 36.1℃ (96.98 ℉), Hypoxemia and mild pulmonary edema were observed. Echocardiography showed severe left ventricular dysfunction and normal dimension with ejection fraction &lt; 10 %. As BP was decreased despite inotropic agents with aggravated hypoxemia, deteriorated acute kidney injury, mechanical ventilation, venous arterial extracorporeal membrane oxygenation (VA-ECMO), and continuous renal replacement therapy were initiated. Coronary angiography revealed normal coronary arteries and the possibility of myocarditis was low because endomyocardial biopsy showed rare inflammatory infiltration. After a few days, other parameters including cardiac function were improved and VA-ECMO was stopped, however, ischemic signs of the right lower leg progressed. To rule out rhabdomyolysis and compartment syndrome, CT angiography was done and about 4.9 cm sized left adrenal mass was found (A). The results of catecholamines are as follows: plasma metanephrine, 1862.6 (&lt; 98.6 pg/mL); normetanephrine, 993.8 (&lt; 164.9 pq/mL); 24hr urine metanephrine, 1396.2 (36~229 mcg/24hr); normetanephrine, 835.8 (95~650 mcg/24hr). A diagnosis of pheochromocytoma was made and left adrenalectomy was done, Pheochromocytoma was demonstrated in biopsy. Unfortunately, due to severe vasoconstriction and rhabdomyolysis, her right leg was not completely recovered, so amputation was done below knee (B). Discussion: Pheochromocytomas are catecholamine secreting tumors derived from chromaffin cells in the adrenal medulla. Catecholamine-induced vasoconstriction, microvascular hypoxia, muscle ischemia, direct toxic effects are considered to contribute to cardiomyopathy and limb ischemia in rare situations. Timely clinical suspicion, prompt diagnosis, and therapeutic intervention are critical.
Abstract 13679: Arterial Stiffness and Carotid Intima-Media Thickness Progression Preceding Worsening Left Ventricular Hypertrophy and Diastolic Dysfunction in Youth: A Temporal Causal Longitudinal Study
Authors: Andrew O Agbaje, Justin P Zachariah, Tomi-Pekka Tuomainen
Journal: Circulation (2022)

Introduction: Left ventricular hypertrophy (LVH) is a marker of cardiovascular events and is driven by ventriculo-vascular interactions with stiffening arteries. But longitudinal relations of left ventricle with aorta is uncharacterized in youth. Hypothesis: Aortic stiffening, measured as change in carotid-femoral pulse wave velocity (cfPWV), and arterial thickening measured as change in carotid intima-media thickness (cIMT) each independently predicts and precedes changes in LVH indices even after adjustment for BP. Methods: From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 adolescents (1011 females) were assessed at mean age 17.7 years and followed for 7 years. Vicorder measured cfPWV and ultrasound measured cIMT were grouped in tertiles as low (reference), moderate, and high. Echocardiography measured cardiac abnormalities are left ventricular mass indexed for height 2.7 (LVMI 2.7 ) ≥51g/m 2.7 as LVH; relative wall thickness ≥44 as hiRWT; LV diastolic function E/A as ≥1.5 (LVDD); and LV filling pressure E/e’ ≥8 as hiLVFP. Data were analysed with generalized logit mixed-effect model and cross-lagged structural equation path model adjusting for cardiometabolic and lifestyle factors. Results: Over follow-up, LVH prevalence increased from 3.6% to 7.2% and LVDD from 11.1 to 16.3%. High cfPWV progression was associated with worsening LVH [Odds ratio 1.23 (1.13 - 1.35); p&lt;0.001] and worsening hiLVFP [1.14 (1.13 - 1.14); p&lt;0.0001]. Likewise, high cIMT progression was associated with worsening LVH [1.27 (1.26 - 1.27); p&lt;0.0001] and worsening hiLVFP [1.17 (1.07 - 1.28); p&lt;0.001]. Neither cfPWV nor cIMT progression was associated with worsening hiRWT nor LVDD. In cross-lagged models, higher baseline cfPWV was associated with future LVMI 2.7 (β=0.06, SE, 5.14, p=0.035), RWT, LVDF, and LVFP. However, baseline LVMI 2.7 , RWT, LVDF, and LVFP were not associated with follow-up cfPWV. Baseline cIMT was not associated with follow-up cardiac indices and vice versa . Conclusions: Youth aortic stiffness progression temporally preceded and may causally associate with worsening LVH and hiLVFP but not hiRWT. Mechanistic delineation of coupling in ventriculo-vascular remodeling and consequent physiologic dysfunction is warranted.
Abstract 13586: In Patients With Left Bundle Branch Block, QRS Duration is a Stronger Predictor of Left Ventricular Hypertrophy and Dilation Than QRS Voltage
Authors: Ashley DeBauge, Tyan Fairbank, Christopher J Harvey, Sagar Ranka, Sania Jiwani, Seth H Sheldon, Madhu Reddy, Timothy A Beaver, Amit Noheria
Journal: Circulation (2022)

Introduction: ECG criteria for left ventricular (LV) hypertrophy in absence of left bundle branch block (LBBB) rely on QRS amplitudes. ECG correlates of LVH in setting of LBBB are not well established. We sought to evaluate quantitative LBBB ECG predictors of echocardiographic LV measurements [LV mass, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF)]. Hypothesis: QRS duration (QRSd) is a better predictor of LV hypertrophy than QRS amplitudes. Methods: We included adult patients with typical LBBB having ECG and echocardiogram performed within 3 months of each other in 2010-2020. Digital 12-lead ECGs were processed to reconstruct orthogonal X, Y, Z leads using Kors matrix. Amplitudes and voltage-time-integrals (VTIs) from all 12 leads, X, Y, Z leads and 3D (root-mean-square) ECG, and QRSd were evaluated. We used age, sex and BSA-adjusted linear regressions to predict LV measurements, and separately generated ROC curves for identifying LV abnormalities. Results: We included 413 patients (53% women, age 73±12 yr). Among all the ECG variables, QRSd was most strongly correlated with all 4 LV measurements (all p&lt;0.00001, see Table 1a showing QRSd compared to VTI and amplitude from 3D QRS). Table 1b shows area under ROC curves to identify LV abnormalities. QRS duration ≥150 ms in women had sensitivity 56.3%, specificity 64.4% for LVMi &gt;95 g/m 2 and sensitivity 62.7%, specificity 67.8% for LVEDVi &gt;61 mL/m 2 . QRS duration ≥160 ms in men had a sensitivity 63.1%, specificity 72.1% for LVMi &gt;115 g/m 2 and sensitivity 58.3%, specificity 74.5% for LVEDVi &gt;74 mL/m 2 . Conclusions: In patients with LBBB, QRS duration ≥150 in women and ≥160 in men is a superior predictor of adverse LV remodeling esp. eccentric LV hypertrophy/dilation. The weak correlation of QRS amplitude with hypertrophy may be due to the dominant effect of electrical dyssynchrony on voltage, and the heterogeneous effects of fibrosis, infiltrative cardiomyopathy, epicardial fat and LV dilation.
Abstract 13858: The Epidemiological Characteristics &amp; Outcome Trend of Cannabis Abuse Among Stroke Hospitalizations in the United States - A Nationwide Study
Authors: Neel Patel, Urvish K Patel, Aakriti Dhiman, Arpankumar Patel, Mahesh Babu Tatineni, Goranti Jyothsna, Vipul Vihar Rakhunde, Pardeep Kumar Sajnani, mahika khurana, Kiran Nagdeo, Hardik Sonani, Shamik Shah, Nils Hennig
Journal: Circulation (2022)

Background: With the legalization of cannabis in many states for medical or recreational purposes, cannabis utilization has been increased to treat various health concerns. However, little is known about the prevalence of cannabis abuse and outcome trend among acute ischemic stroke (AIS) patients. This study examines the epidemiological characteristics and outcome trend of cannabis abuse among adults with AIS hospitalizations in the USA. Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample over year from 2003 to 2017 in adult hospitalizations for AIS to compare the outcomes [death, risk mortality &amp; discharge disposition (short-term hospital / skilled nursing home/home health care)] in cannabis abusers using ICD 9 &amp; 10 codes. We performed weighted analyses using chi-square, t-test, and Cochran-Armitage trend test. Results: Amongst the total of 5,690,773 AIS hospitalizations, 50,895 (0.89%) cannabis users were identified from 2003 to 2017. The prevalence trend of cannabis abuse has increased among stroke hospitalizations (2003: 0.22% to 2017:1.64%; p-trend &lt; 0.0001). The cannabis abuse was higher among the younger to middle age compared to older aged stroke hospitalization (&lt;50 year: 3.89% vs 50-75 year: 1.09% vs &gt;75 year: 0.02%; p &lt;0.0001). Cannabis abuse was more prevalent among the male (1.32% vs female: 0.50%), Black (2.29% vs White: 0.61%; p&lt;0.0001). The cannabis abusers had lower median household income (1.39% vs higher income:0.44%), medicaid insurance (3.61% vs medicare: 0.31%), highly prevalent in midwest (1.05% vs northeast: 0.57%; p&lt;0.0001). There was also increased trend in mortality (2003: 0.38% to 2017: 0.97%), extreme/major likelihood of dying (2003: 0.21% to 2017: 1.22%), extreme/major loss of function (2003: 0.19% to 2017: 1.52%), discharge to non-home (2003: 0.14% to 2017: 1.25%; p-trend&lt;0.0001) among cannabis abusers following stroke hospitalizations. Conclusion: This study identified a higher prevalence of abuse, abuse-related poor outcomes, and higher stroke-related mortality among stroke survivors. Cannabis use in patients with neurovascular insults has raised safety concerns, and more long-term research is needed to determine its risks and benefits in stroke patients.